Pseudo-madelung deformity (post trauma)
Delivery man with a history of chronic wrist pain.
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This patient had a history of trauma as a child and his adult wrist has marked ulnar tilt of the radiocarpal articulation reminiscent of Madelung deformity. The distal ulna also appears dysmorphic.
A careful study of the wrist, though, shows that many of the features of Madelung deformity are absent:
- no dorsal subluxation of the distal ulna and positive ulnar variance
- no wedging of the carpus between the radius and ulna
- no dorsal and radial bowing of the radius
- no failure of ossification of the ulnar side of the distal radial epiphysis
- no “V-shaped” proximal carpal row (herniated proximal carpal row)
In fact, the carpals appear pretty much normal, although they are ulnarly displaced.
This case highlights what actually defines the Madelung deformity. Although the post-traumatic healing process of this patient resulted in some features reminiscent of Madelung deformity, many other features are absent, and this results in a sort of "pseudo" Madelung. In particular, the marked shortening of the distal ulna is not typical of Madelung deformity, and even suggest a possible prior distal ulnar resection (which was not in this patient's history).
Trauma is often listed as one of the aetiologies of Madelung deformity, but in order to diagnose a post-traumatic Madelung deformity, the ulna should be distal to the medial distal radius and the distal ulna should be dorsally subluxed.